Effect of intraoperative magnesium sulphate on acute kidney injury following robot-assisted radical prostatectomy: a retrospective propensity score-matched analysis

Although intraoperative magnesium sulphate administration has various advantages, its influence on the occurrence of postoperative acute kidney injury (AKI) remains unclear, particularly in patients undergoing robot-assisted radical prostatectomy (RARP). The steep Trendelenburg position and a high intra-abdominal pressure can render patients susceptible to AKI after surgery. This study aimed to evaluate the effects of intraoperative magnesium sulphate administration on postoperative AKI in patients who underwent RARP. This retrospective study used a propensity score-matched analysis to evaluate the medical records of patients who underwent RARP between May 2013 and December 2021 in a single institution. In total, 3,239 cases were reviewed. After propensity score matching, 456 patients were each included in the magnesium and control groups. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for postoperative AKI, as defined by the Kidney Disease Improving Global Outcomes criteria, within seven days after surgery. The incidence of postoperative AKI did not differ significantly between the magnesium and control groups (30.7% versus 31.4%). The univariate logistic regression analysis revealed that intraoperative magnesium sulphate administration was not associated with AKI after RARP (p=0.83). In the multivariate analysis, body mass index (odds ratio [OR], 1.069; p=0.018) and duration of surgery (OR, 1.005; p=0.027) were independent risk factors, while total intravenous anaesthesia (OR, 0.448; p=0.005) and intraoperative fluid replacement (OR, 0.856; p=0.012) were protective factors for postoperative AKI. Intraoperative magnesium sulphate administration had no significant effect on the occurrence of postoperative AKI in patients undergoing RARP.